Accountable Care Organizations The Future Integrated Health Care Delivery Model?

Size: px
Start display at page:

Download "Accountable Care Organizations The Future Integrated Health Care Delivery Model?"

Transcription

1 Accountable Care Organizations The Future Integrated Health Care Delivery Model? Maria T. Currier Randy Fenninger Holland & Knight LLP Adventist Health System Annual Legal Retreat October 25, 2010 Orlando, Florida Copyright 2010 Holland & Knight LLP All Rights Reserved

2 Discussion Items ACOs and Their Role in Health Reform Many Unanswered Questions The Inter-Agency Meetings in DC Possible ACO Structural Models for Health System Antitrust and Clinical Integration Issues Fraud and Abuse, Stark and CMP Considerations State Law Issues 2

3 Accountable Care Organizations (ACOs)- The Future of Health Care Delivery? Is this the only real reform of the health care delivery system in the Patient Protection and Affordable Care Act (PPACA)? 3

4 What The PPACA Does Insures 35 million uninsured Americans by adding 20 million to Medicaid and creating the state health benefit exchanges to expand the market for individuals and small business. Adds extensive new federal regulation of private health insurance plans. Expands quality, innovation and efficiency efforts through new demonstration projects and pilot programs. 4

5 What The PPACA Does Not Do Does not insure every person in the country. 23 million will remain uninsured Does not create a new payment system. Medicaid, Medicare, employer-provided, medigap, and state exchangebased insurance will coexist; fee-for-service payment will still be the standard. Does not restructure the delivery of health care, but sets in motion a potentially significant change-the ACO. 5

6 What is an ACO? Sections 3022 and of the PPACA (PL ) set out the framework for Medicare ACOs to be implemented by January 1, However, CMS still has to issue rules before stakeholders can decide to participate. A proposed rule is to be issued by the end of The basic premise for ACOs is that they can facilitate medical care coordination among providers to improve the quality of care for Medicare beneficiaries and reduce unnecessary spending. Private health plans could also find ways to work with Medicare qualified ACOs. The ACO provisions are part of the law s Medicare Shared Savings programs, sending the clear signal that ACOs will be expected to reduce Medicare spending. 6

7 Administration Sees the ACO as a Key Element in Health Reform White House has hosted meetings on ACOs. White House is pushing regulators (CMS, OIG, FTC and others) to find ways to make ACOs work. White House is pushing CMS to have listening sessions with stakeholders before writing the draft rules and has set an aggressive rulemaking schedule. 7

8 Here Is What the PPACA Says About ACOs An Accountable Care Organization is defined as an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries enrolled in the traditional fee-for-service program who are assigned to it. For ACO purposes, assigned means those beneficiaries for who the professionals in the ACO provide the bulk of primary care services. Assignment will be invisible to the beneficiary, and will not affect their guaranteed benefits or choice of doctor. 8

9 Here Is what the PPACA Says About ACOs (continued) A beneficiary may continue to seek services from the physicians and other providers of their choice, whether or not the physician or provider is a part of an ACO. Organizations that may become a Medicare recognized ACO include: Physicians and other professionals in group practices; Physicians and other professionals in networks of practices; Partnerships or joint venture arrangements between hospitals and physicians/professionals; Hospitals employing physicians/professionals; and Other forms that HHS may determine to be appropriate. 9

10 More PPACA Requirements Requirements an organization will have to meet to be a Medicare ACO Have a formal legal structure to receive and distribute shared savings; Have a sufficient number of primary care professionals for the number of assigned beneficiaries, which will be 5,000 at a minimum; Agree to participate in the program for at least a 3-year period; Have sufficient information regarding participating ACO health care professionals as the Secretary determines necessary to support beneficiary assignment and for the determination of payments for shared savings; Have a leadership and management structure that includes clinical and administrative systems; Have defined processes to (a) promote evidenced-based medicine, (b) report the necessary data to evaluate quality and cost measures (this could incorporate requirements of other programs, such as the Physician Quality Reporting Initiative (PQRI), Electronic Prescribing (erx), and Electronic Health Records (EHR)), and (c) coordinate care; and, Demonstrate it meets patient-centeredness criteria, as determined by the Secretary, such as the use of individualized care plans. 10

11 More PPACA Requirements (continued) Qualifying for Shared Savings CMS will set annual Medicare savings benchmarks for ACOs based on previous per-beneficiary expenditures for Parts A and B services. the benchmark for each ACO will be adjusted for beneficiary characteristics and other factors determined appropriate by the Secretary, and updated by the projected absolute amount of growth in national per capita expenditures for Part A and B. ACOs that meet the specified quality performance standards will be eligible to receive a share of any savings if the actual per capita expenditures of their assigned Medicare beneficiaries are a sufficient percentage below their specified benchmark amount. There are no penalties for ACOs that do not meet the savings targets. 11

12 Potential Legal Conflicts ACOs could run afoul of several federal laws Stark Anti-kickback Civil money penalties Antitrust Federal Trade Commission 12

13 Will the Legal Conflicts Be Resolved? The Secretary of HHS has authority to waive many Medicare requirements that might impede the development of ACOs but must seek cooperation of other agencies to waive other laws. FTC, OIG and CMS held a public meeting to discuss these problems and hear from stakeholders. Requires complex, nearly simultaneous rulemaking to avoid conflicts and encourage participation. 13

14 Other Issues to be Resolved The lack of specificity in the statute and the limited real world experience with ACOs means that there are many important questions that will need to be addressed by federal regulators and potential participants. Will the shared savings justify the costs of becoming an ACO? Can ACOs control costs and maintain quality if they don t control all of the patient s medical services? What mechanism will CMS use to assign beneficiaries to ACOs? What criteria will CMS use to determine who qualifies to be an ACO? How is CMS going to assess quality across diverse organizations with different patient populations? On what basis will CMS attribute savings? How will specialists participate in ACOs? Are there state and federal tax implications if for-profit medical practices and not-for-profit hospitals and other institutions try to form join venture ACOs? Keep an eye on MedPac and the Physician Group Participation (PGP) Demonstration Project 14

15 ACOs: Legally Flexible Concept Example of existing entities that can qualify: An IDS with hospitals, physicians and other providers under common control Affiliated Provider Network (clinically and/or financially integrated) An MSO Integration Model (EMR deployment) with Affiliated IPA Multispecialty Group Practice PHO (clinically and/or financially integrated) A joint venture of two or more of the aforementioned 15

16 Affiliated Physician Organization ACO Model Health System Parent Hospital ACO Affiliated Group Practice Payors 16

17 Physician-Hospital Organization (PHO)- ACO Model Health System Hospital Physician Organization ACO Payors 17

18 MSO Integration ACO Model System Parent Payor MSO/ACO Hospital IPA MD MD MD 18

19 Hospital Physician Employment ACO Model Health System Hospital ACO Payors e 19

20 Comprehensive Health System ACO Model Health System Affiliated Medical Group Hospital Home Health Clinics SNF IPA ACO Community Physicians Payors 20

21 ACO Challenges: Financial & Governance Multiple Payors providing inconsistent incentives Cost of Infrastructure/EMR Decisions on Dollar Allocations Composition of ACO Governing Board (Physician Leadership) Decision Making Committees (Compensation, Finance, Quality, Technology) Moving from Shared Savings model (Level I ACO) to Bundled (hospital-physician) and Capitation (Level III ACO) Payments 21

22 Legal Challenges and Considerations Antitrust Issues Clinical Integration-what is it? Anti-kickback/Stark/CMP Laws Tax Exemption Patient Privacy and Sharing Data Florida State Law Issues 22

23 Antitrust Issues: Can ACO participants jointly contract with Payors? Agreements between two or more non-integrated entities that unreasonably restrains trade prohibited [Sherman Act Sec 1] If providers in an ACO are considered a single entity they are incapable of violating Section 1 If not considered a single entity, do the ACO providers demonstrate sufficient financial and/or clinical integration? 23

24 Antitrust (cont.) 1996 FTC DOJ Health Care Statements of Antitrust Enforcement Guidance are Outdated New Safety Zones for ACOs that achieve health reform goals (improved care at lower costs) are needed Financial Integration (Capitation, Bundled Payments) Clinical Integration - The New Normal 24

25 Clinical Integration-What Is It and Why Is It Important? Factors relevant to FTC analyses of clinical integration programs, Instructive Favorable Advisory Opinions Participants accountable for care outcomes Evidence based clinical protocols and processes outcomes Use of health information technology Non-exclusive contracting by physicians Joint contracting is ancillary to expected procompetive (expanding service, cost savings, measured quality improvement) 25

26 Antitrust Market Power Must be Considered Market Power Overinclusive Foreclosures on competition Safety zones? 26

27 Anti-kickback/Stark/CMP Laws Current legal framework focuses on abuses of FFS Payment System (over-utilization, payment for referrals, underutilization of needed hospital care) Health Reform will change the existing Payment System New Financial Relationships emerge from ACO Models that do not fit the existing legal paradigm 27

28 New ACO Financial Relationships: MD $ MD $ IPA Hospital MD $ $ $ $ ACO $ Payor 28

29 New ACO Financial Relationships: ACOs receipt of payment from Payor ACOs payments to the providers Distributions to the ACO owners Other potential relationships between/among the providers outside the ACO structure Is the ACO a provider on its own? How are specific payment models addressed (Shared Savings Program, Bundled and Capitation Models) 29

30 New ACO Shared Savings/Gainsharing Arrangements These arrangements have been analyzed (but not in context of ACOs) OIG Gainsharing Opinions (AKS/CMP) Stark Proposed Exception (July 2008) Employment exceptions (under AKS and Stark) Are these sufficient to work in ACO context using Shared Savings Model (in 2012) Advisory Opinions and Proposed Stark Exception are narrow and have numerous Safeguards 30

31 Shared Savings/Gainsharing: Safeguards Evidentiary support for quality/performance targets Certain Targets may be inappropriate (which ones?) Need historical and clinical measures to set the targets Written disclosure to Patients No disproportionate focus on Medicare/Medicaid Per capita distributions to physicians Reasonable time limit (1-3 years) Amount of incentive limited Participation restricted to existing physicians on medial staff (no new referrals) 31

32 Bundled Hospital-Physician Payments: Stark What Stark exceptions are available for these payments from ACO to participants? Hospital ACO Payor MD e Affiliated Medical Group Bundled Payment for Episode of Care Employment? Risk Sharing? Personal Services/FMV/Indirect Compensation? 32

33 Bundled Hospital-Physician Payments: AKS What Safe Harbors are available for ACO payments to providers? Hospital ACO Payor e Bundled Payment for Episode of Care MD Affiliated Medical Group Employment? Risk Sharing? Personal Services/Management Contract Safe Harbor (set in Advance, FMV, not based on V/V of referrals or other business)? 33

34 Bundled Hospital-Physician Payments: CMP Is Hospital payment involved? Hospital ACO Payor e Bundled Payment for Episode of Care MD Affiliated Medical Group Physician Incentive Payment Rules (PIP)? Need additional flexibility for new ACO Models 34

35 ACO-Tax Exemption? Key 501(c)(3) Consideration: ACO must organize and operate exclusively (primarily) for charitable purposes and No private benefit (de minimus amount of earnings/profits may be distributed to nonexempt entities or individuals, non-insiders) No Private Inurement (physicians are insiders; per se violation, no de minimus exception) 35

36 ACO-Tax Exemption (cont d) Key Questions: Can Nonprovider ACO contracting entity be tax-exempt? IRS Rulings on PHOs and MSOs are instructive Community benefit analysis (reducing health care costs and medical errors furthers charitable purpose provision of health care services not necessary; Community Board emphasis) Will participation in a taxable ACO jeopardize 501(c)(3) health system status? 36

37 Sharing Patient Data in ACOs HIPAA Analysis: Can ACO Providers share PHI? Affiliated Covered Entities ACO with two or more covered entities under common control acts as a single CE for HIPAA Compliance Organized Health Care Arrangement (OHCA) ACOs separately owned covered entities may share PHI to manage any joint health care operations ACO/MSO Integration Model ACO Participants have a Business Associate Agreement with the MSO 37

38 ACO Affiliated Covered Entities: HIPAA Health System Parent ACO Hospital Affiliated Physician Group Nursing Home ACO Participants 38

39 ACO OHCA Sharing: HIPAA ACO Payor Hospital PHI Cardiology Group PHI (Separately Owned Covered Entities) Co-Management of Cardiovascular Service Line Program Contractual JV Hospital/Physician Committee 39

40 ACO/MSO Integration Model: HIPAA MSO ACO Payor BA Agreements Hospital PHI IPA PHI Ancillary Providers ACO Participants 40

41 Florida State Law Issues for ACOs Health Care Clinic Act Patient Brokering Act/Fee-Splitting Prohibition State Patient Privacy Laws Fiscal Intermediary Service Organization ( FISO ) Third Party Administrator ( TPA ) license 41

42 Florida State Law Issues (cont d) Health Care Clinic Act Is the ACO entity a CLINIC does ACO provide health care services and tender charges for reimbursement of services Non Provider ACOs should not be subject to Licensure Provider ACOs may be exempt from (e.g. ACOs owned by hospitals) 42

43 Florida State Law Issues (cont d) Patient Brokering Act [ F.S.] Criminal Statute prohibiting of any commission, rebate, bonus, kickback, or engaging in split fee arrangements in return for referring patients/patronage to a health care provider New financial arrangements among ACO participants and new payment models raise issues If AKS Safe Harbor Met home free 43

44 Florida State Law Issues (cont d) Patient Privacy Laws Florida stricter than HIPAA Notice of Privacy Practice Inclusion of ACO uses of medical information Patient Consent authorizing disclosure to ACO and purpose of disclosures/uses/healthcare operations Treatment of Sensitive Information (HIV, substance abuse, mental health) 44

45 Florida State Law Issues (cont d) Fiscal Intermediary Services Organization Registration [ ] Does ACO perform fiscal intermediary services requiring registration? Passed in 1997 to deal with companies that arranged and administered provider networks for HMOs FISO services include: receiving reimbursements on behalf of providers, performing accounting, financial reporting, compensation and other fiduciary services for providers pursuant to their contracts with HMOs Exempted entities: FISO owned by hospitals, insurers, TPAs, physician group practices Non Provider ACOs contracting with HMOs may be subject to registration (Fidelity bond requirements) 45

46 Florida States Law Issues (cont d) Third Party Administrator [ F.S.] Is ACO an administrator? Does it adjust or settle claims for ERISA plans, health insurers, under health care risk contracts with an insurer/hmo, or perform billing and collection services on behalf of health care providers? Possible Exemption: ACOs for hospitals providing billing claims and collection services solely for hospital and its physicians behalf for services under the scope of Chapter

47 Next Steps: Assess the Systems Accountable Care Capabilities What Scope of Services will be offered through the ACO? Which Providers and Care Settings should be involved? What is the status of Clinical Integration (processes and technology EMR/EH strategies)? What is the geographic market (any Market Power concerns)? Consider participating in ACO Rule Making Process Begin exploring possible ACO Models Assess commercial payor interest to test innovate payment projects through the ACO Assess system s ability to assume risk through an ACO model Consider participation in Demonstration/Pilot programs ( First-Mover Advantages ) 47

48 Questions and Discussion 48

Accountable Care Organizations Understanding What They Are and How to Structure Them

Accountable Care Organizations Understanding What They Are and How to Structure Them Accountable Care Organizations Understanding What They Are and How to Structure Them Maria T. Currier HOLLAND & KNIGHT LLP Miami Chamber of Commerce Healthcare Subcommittee December 7, 2010 Copyright 2010

More information

Accountable Care Organizations: Legal and Organizational Structures; Governance

Accountable Care Organizations: Legal and Organizational Structures; Governance Accountable Care Organizations: Legal and Organizational Structures; Governance The National Accountable Care Organization Congress October 25-27, 2010 Los Angeles, CA Dennis S. Diaz, Esq. Davis Wright

More information

2010 MHA Governance Leadership Forum: Accountable Care Organizations. Chris Rossman, Esq. Foley & Lardner LLP Detroit, Michigan

2010 MHA Governance Leadership Forum: Accountable Care Organizations. Chris Rossman, Esq. Foley & Lardner LLP Detroit, Michigan 2010 MHA Governance Leadership Forum: Accountable Care Organizations Chris Rossman, Esq. Foley & Lardner LLP Detroit, Michigan Overview Major health care payment reform under the Affordable Care Act (

More information

Large Urology Group Practice Association. Accountable Care Organizations

Large Urology Group Practice Association. Accountable Care Organizations Large Urology Group Practice Association Accountable Care Organizations November 6, 2010 J. Phillip O Brien 312.902.5630 phillip.obrien@kattenlaw.com Basic Premise for ACOs Facilitate medical care coordination

More information

Legal & Policy Issues Related to ACO Formation by Independent Physician Groups

Legal & Policy Issues Related to ACO Formation by Independent Physician Groups Legal & Policy Issues Related to ACO Formation by Independent Physician Groups Troy Barsky Arthur Lerner Crowell & Moring LLP America s Health Insurance Plans ACO Summit May 15, 2013 Background Government

More information

In early April, the Center for Medicare and Medicaid Services (CMS) issued

In early April, the Center for Medicare and Medicaid Services (CMS) issued April 26, 2011 If you have any questions regarding the matters discussed in this memorandum, please contact the following attorneys or call your regular Skadden contact. John T. Bentivoglio 202.371.7560

More information

Guidance Released on Accountable Care Organizations Participating in the Medicare Shared Savings Program

Guidance Released on Accountable Care Organizations Participating in the Medicare Shared Savings Program M A Y 2 0 1 1 Guidance Released on Accountable Care Organizations Participating in the Medicare Shared Savings Program On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS), the Department

More information

Statement of the Association of American Medical Colleges on Legal Issues Related to Accountable Care Organizations and Healthcare Innovation Zones

Statement of the Association of American Medical Colleges on Legal Issues Related to Accountable Care Organizations and Healthcare Innovation Zones Statement of the Association of American Medical Colleges on Legal Issues Related to Accountable Care Organizations and Healthcare Innovation Zones Public Workshop hosted by the FTC, CMS, HHS OIG October

More information

The Accountable Care Organization

The Accountable Care Organization The Accountable Care Organization Kim Harvey Looney kim.looney@ 615-850-8722 3968555 1 ACOs: Will I Know One When I See One? Relatively New Concept Derived from Various Demonstration Programs No Set Structure

More information

The Role of Accountable Care Organizations in the New World of Federal and State Health Care Reform

The Role of Accountable Care Organizations in the New World of Federal and State Health Care Reform The Role of Accountable Care Organizations in the New World of Federal and State Health Care Reform May 5, 2010 Daniel T. Roble Ropes & Gray LLP daniel.roble@ropesgray.com 617.951.7476 Michele M. Garvin

More information

Accountable Care Organizations. Rick Shinto, MD Aveta Health Inc. July 20, 2010

Accountable Care Organizations. Rick Shinto, MD Aveta Health Inc. July 20, 2010 Accountable Care Organizations Rick Shinto, MD Aveta Health Inc. July 20, 2010 1 Health Care Reform- New Models of Care Patient Protection and Affordable care Act (PPACA 2010) controlling costs and improving

More information

Accountable Care Organizations and Provider Integration Under Health Care Reform. Sarah Swank 202.326.5003 seswank@ober.com

Accountable Care Organizations and Provider Integration Under Health Care Reform. Sarah Swank 202.326.5003 seswank@ober.com Accountable Care Organizations and Provider Integration Under Health Care Reform Sarah Swank 202.326.5003 seswank@ober.com February 26, 2014 Overview Affordable Care Act and ACOs Trends in Integration

More information

CLINICALLY INTEGRATED NETWORKS: BUSINESS AND LEGAL CONSIDERATIONS

CLINICALLY INTEGRATED NETWORKS: BUSINESS AND LEGAL CONSIDERATIONS CLINICALLY INTEGRATED NETWORKS: BUSINESS AND LEGAL CONSIDERATIONS Claire Turcotte, Esquire, Bricker & Eckler LLP Jim Yanci, MS MT (ASCP), Dixon Hughes Goodman Agenda BUSINESS CONSIDERATIONS How Fast are

More information

The true meaning of ACO is Awesome Consulting Opportunities. - The Weekly Standard, 04/12/11. Consultants

The true meaning of ACO is Awesome Consulting Opportunities. - The Weekly Standard, 04/12/11. Consultants Accountable Care Organizations: Proposed Regulations and the Local Landscape May 26, 2011 John Clark, MD, JD Isaac M. Willett Medical Director, Clinical i l Informatics Attorney Indiana University Health

More information

Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare

Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare December 2010 Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare CONTENTS Background... 2 Problems with the Shared Savings Model... 2 How

More information

NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. Briefing Paper on the Proposed Medicare Shared Savings Program

NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. Briefing Paper on the Proposed Medicare Shared Savings Program NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS Briefing Paper on the Proposed Medicare Shared Savings Program The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule to implement

More information

PROPOSED MEDICARE SHARED SAVINGS (ACO) PROGRAM RULES

PROPOSED MEDICARE SHARED SAVINGS (ACO) PROGRAM RULES PROPOSED MEDICARE SHARED SAVINGS (ACO) PROGRAM RULES The Centers for Medicare and Medicaid Services (CMS) and other affected agencies released their notice of proposed rulemaking/request for comment for

More information

BAKER DONELSON BAKER S DOZEN

BAKER DONELSON BAKER S DOZEN Thirteen Things Health Care Providers Should Know About Accountable Care Organizations and Health Reform Thomas E. Bartrum, 615.726.5641, tbartrum@bakerdonelson.com With passage of the Patient Protection

More information

ACO Strategy and Organizational Structure

ACO Strategy and Organizational Structure ACO Strategy and Organizational Structure Health Care Group November 16, 2010 Tax & Benefits Group Daniel T. Roble Ropes & Gray daniel.roble@ropesgray.com 617.951.7476 Lorry Spitzer Ropes & Gray lorry.spitzer@ropesgray.com

More information

Hospital and Independent Physician Alignment: Structural Options, Business and Compliance Considerations

Hospital and Independent Physician Alignment: Structural Options, Business and Compliance Considerations Hospital and Independent Physician Alignment: Structural Options, Business and Compliance Considerations By Bruce A. Johnson and Janice Anderson I. Introduction Numerous policy initiatives are now being

More information

Additional Information About Accountable Care Organizations

Additional Information About Accountable Care Organizations Additional Information About Accountable Care Organizations For more information, please contact: April 2011 On March 31st, the federal government outlined proposed actions relating to Accountable Care

More information

Legal Issues for Accountable Care Organizations

Legal Issues for Accountable Care Organizations Legal Issues for Accountable Care Organizations Health Care Reform Strategies Bruce Merlin Fried, Esq. ACO Summit June 7, 2010 ACOs in PPACA The Basics Section 3022 of the Protection and Affordable Care

More information

A Closer Look at the Final ACO Rule

A Closer Look at the Final ACO Rule A Closer Look at the Final ACO Rule October 2011 For more information, please contact: On October 20th, the federal government released a final rule and other companion releases relating to Accountable

More information

CMS Releases Proposed Rule Governing Accountable Care Organizations

CMS Releases Proposed Rule Governing Accountable Care Organizations CMS Releases Proposed Rule Governing Accountable Care Organizations Health Care Organizations Face Complex Strategic Decisions Authors: Robert D. Belfort Paul M. Campbell Susan R. Ingargiola Stephanie

More information

INTEGRATION STRATEGIES FOR A NEW HEALTH CARE ECONOMY

INTEGRATION STRATEGIES FOR A NEW HEALTH CARE ECONOMY INTEGRATION STRATEGIES FOR A NEW HEALTH CARE ECONOMY Thomas William Baker Baker Donelson Bearman Caldwell & Berkowitz, P.C. Atlanta, Georgia (404) 221-6510 tbaker@bakerdonelson.com Prepared for East Georgia

More information

Provider Participation in ACOs May Hinge on HHS Regulations

Provider Participation in ACOs May Hinge on HHS Regulations Source: Health Law Reporter: News Archive > 2010 > 04/15/2010 > BNA Insights > Provider Participation in ACOs May Hinge on HHS Regulations Provider Participation in ACOs May Hinge on HHS Regulations 19

More information

January 14, 2011. Dear Chairman Issa:

January 14, 2011. Dear Chairman Issa: The Honorable Darrell Issa Chairman Committee on Oversight and Government Reform U.S. House of Representatives 2157 Rayburn House Office Building Washington, D.C. 20515 Dear Chairman Issa: On behalf of

More information

HEALTH REFORM LAW: ACCOUNTABLE CARE ORGANIZATIONS

HEALTH REFORM LAW: ACCOUNTABLE CARE ORGANIZATIONS HEALTH REFORM LAW: ACCOUNTABLE CARE ORGANIZATIONS PRESENTED AT THE NASABA 2011 CONVENTION BY: PURVI B. MANIAR Context and Background Patient Protection and Affordable Care Act of 2010 ( PPACA ) (Section

More information

G-2. Report. Compliance. An ambitious health reform subtitle, Transforming the Health

G-2. Report. Compliance. An ambitious health reform subtitle, Transforming the Health G-2 Kimberly Scott, Managing Editor, kscott@ioma.com Carrie Valiant is a senior member of the health care and life sciences practice of the national law firm, EpsteinBeckerGreen, practicing in its Washington,

More information

Accountable Care Organizations

Accountable Care Organizations Accountable Care Organizations Implications Under Physician Self-Referral, Anti-Kickback, Civil Monetary Penalty and Antitrust Laws Michael R. Callahan 312.902.5634 michael.callahan@kattenlaw.com J. Phillip

More information

Amy K. Fehn. I. Overview of Accountable Care Organizations and the Medicare Shared Savings Program

Amy K. Fehn. I. Overview of Accountable Care Organizations and the Medicare Shared Savings Program IMPLEMENTING COMPLIANCE PROGRAMS FOR ACCOUNTABLE CARE ORGANIZATIONS Amy K. Fehn I. Overview of Accountable Care Organizations and the Medicare Shared Savings Program The Medicare Shared Savings Program

More information

Accountable Care Organizations Multiple Comment Periods

Accountable Care Organizations Multiple Comment Periods Accountable Care Organizations Multiple Comment Periods Proposed Waivers CMS and OIG CMS and HHS Office of Inspector General (OIG) jointly issued a notice with comment period outlining proposals for waivers

More information

Legal Waivers under the Medicare Shared Savings Program: An Overview of the Options

Legal Waivers under the Medicare Shared Savings Program: An Overview of the Options Legal Waivers under the Medicare Shared Savings Program: An Overview of the Options Robert G. Homchick Davis Wright Tremaine LLP Arthur N. Lerner Crowell & Moring LLP Shared Savings Program: ACOs Medicare

More information

ACOs: Fraud & Abuse Waivers and Analysis

ACOs: Fraud & Abuse Waivers and Analysis ACOs: Fraud & Abuse Waivers and Analysis Robert G. Homchick and Sarah Fallows Davis Wright Tremaine, LLP I. Introduction The Patient Protection and Affordable Care Act of 2010 (ACA) fosters the development

More information

KATHLEEN L. DEBRUHL & ASSOCIATES, L.L.C. 614 TCHOUPITOULAS STREET NEW ORLEANS, LOUISIANA 70130 504.522.4054 (OFFICE) 504.522.9049 (FAX) WWW.MD-LAW.

KATHLEEN L. DEBRUHL & ASSOCIATES, L.L.C. 614 TCHOUPITOULAS STREET NEW ORLEANS, LOUISIANA 70130 504.522.4054 (OFFICE) 504.522.9049 (FAX) WWW.MD-LAW. CMS RELEASES PROPOSED ACCOUNTABLE CARE ORGANIZATION REGULATIONS By: Kathleen L. DeBruhl, Esq. and Lindsey E. Surratt, Esq. On March 31, 2011, the Centers for Medicare and Medicaid Services ( CMS ) issued

More information

Fraud and Abuse Considerations for Accountable Care Organizations (ACOs)

Fraud and Abuse Considerations for Accountable Care Organizations (ACOs) Fraud and Abuse Considerations for Accountable Care Organizations (ACOs) By: Chris Rossman, Foley & Lardner LLP, Detroit, Michigan 1. The Centers for Medicare and Medicaid Services ( CMS ) and the Office

More information

II. SHARED SAVINGS PROGRAM AND COST-REDUCTION INCENTIVES

II. SHARED SAVINGS PROGRAM AND COST-REDUCTION INCENTIVES E-ALERT Health Care April 15, 2011 ACCOUNTABLE CARE ORGANIZATION BASICS The Affordable Care Act establishes the Medicare Shared Savings Program ( Program ), which provides for the development of accountable

More information

DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM

DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM 1 DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM Definition of ACO General Concept An ACO refers to a group of physician and other healthcare providers and suppliers

More information

NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. Briefing Paper on the Proposed Medicare Shared Savings Program

NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. Briefing Paper on the Proposed Medicare Shared Savings Program NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS Briefing Paper on the Proposed Medicare Shared Savings Program The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule to implement

More information

Accountable Care Organizations: Experiences, Examples and Lessons Learned

Accountable Care Organizations: Experiences, Examples and Lessons Learned Accountable Care Organizations: Experiences, Examples and Lessons Learned New York State Academy of Family Physicians Downstate Regional Family Medicine Conference Jeffrey R. Ruggiero Arnold & Porter LLP

More information

Accountable Care Organizations: The Final Rule

Accountable Care Organizations: The Final Rule Accountable Care Organizations: The Final Rule October 27, 2011 2011 Akin Gump Strauss Hauer & Feld LLP 10.27.11 101799002 v4 Overview Background Final Rule Highlights Structure and Formation of ACOs Quality

More information

RE: File Code CMS-1345-NC2 Medicare Program Waiver Designs in Connection with the Medicare Shared Savings Program and Innovation Center

RE: File Code CMS-1345-NC2 Medicare Program Waiver Designs in Connection with the Medicare Shared Savings Program and Innovation Center Donald Berwick, M.D., M.P.P. Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1345-NC2 Room 445-G Hubert H. Humphrey Building 200 Independence Ave. S.W.

More information

Payor Perspectives on Provider Realignment and ACOs

Payor Perspectives on Provider Realignment and ACOs Payor Perspectives on Provider Realignment and ACOs Joel L. Michaels March 15, 2011 Overview Issues to be addressed Medicare Shared Savings Program overview ACO organization options Health care reform

More information

HIPAA and Payment Reform ACOs, Medical Home & Bundled Payments

HIPAA and Payment Reform ACOs, Medical Home & Bundled Payments HIPAA and Payment Reform ACOs, Medical Home & Bundled Payments By: Paul T. Smith, Shareholder Hooper, Lundy & Bookman, P.C. psmith@health-law.com 21 st National HIPAA Summit Washington, D.C. February 20,

More information

American Health Lawyers Association

American Health Lawyers Association American Health Lawyers Association Fundamentals of Health Law October 26, 2010 Chicago, Illinois Accountable Care Organizations: How Healthcare Reform Will Transform Hospital-Physician Relations Peter

More information

August 12, 2010. Dear Dr. Berwick:

August 12, 2010. Dear Dr. Berwick: Donald M. Berwick, MD Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services 200 Independence Avenue, SW Room 314G Washington, DC 20201 Dear Dr. Berwick: I am

More information

Federal Health Care Reform: Implications for Hospital and Physician partnerships. Walter Kopp Medical Management Services

Federal Health Care Reform: Implications for Hospital and Physician partnerships. Walter Kopp Medical Management Services Federal Health Care Reform: Implications for Hospital and Physician partnerships Walter Kopp Medical Management Services Outline Overview of federal health reform legislation Implications for Care delivery

More information

Cornerstone Health Care, P.A.

Cornerstone Health Care, P.A. Cornerstone Health Care, P.A. Medicare Shared Savings Program ACO Compliance NAACOS July 2013 Agenda 1. Background 2. Compliance Requirements & Purpose 3. Cornerstone s experience 4. Q&A 2 Cornerstone

More information

ACOs: Navigating The Legal Minefield

ACOs: Navigating The Legal Minefield SMITH ANDERSON ACOs: Navigating The Legal Minefield Accountable Care Organizations ( ACOs ) hold great promise, but they are being placed upon a legal framework premised upon the fee-for-service health

More information

Look Before You Leap: Legal and Practical Obstacles with ACOs

Look Before You Leap: Legal and Practical Obstacles with ACOs Look Before You Leap: Legal and Practical Obstacles with ACOs Houston ACO Conference May 7, 2013 Edward Vishnevetsky, Esq. Coordinated Care and ACOs Coordinated Care Goal: ensure that healthcare providers

More information

Strategy and Options for Alignment and Steps to Create an ACO

Strategy and Options for Alignment and Steps to Create an ACO White Paper Strategy and Options for Alignment and Steps to Create an ACO A Suggested Strategy James M. Daniel, Jr., JD, MBA Hancock, Daniel, Johnson & Nagle, P.C. (866) 967-9604 jdaniel@hdjn.com www.hdjn.com

More information

Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices

Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices Martin Bienstock, Esq. Wilson Elser Martin.Bienstock@WilsonElser.com The New York Times Take... For the first

More information

Fraud & Abuse Waivers Under the Medicare Shared Savings Program

Fraud & Abuse Waivers Under the Medicare Shared Savings Program Fraud & Abuse Waivers Under the Medicare Shared Savings Program Robert G. Homchick Davis Wright Tremaine, LLP I. Introduction The Patient Protection and Affordable Care Act of 2010 (ACA) fosters the development

More information

OHIO HOSPITAL ASSOCIATION 2015 Annual Meeting. Accountable Care Organizations Comprehensive Integration Strategy

OHIO HOSPITAL ASSOCIATION 2015 Annual Meeting. Accountable Care Organizations Comprehensive Integration Strategy OHIO HOSPITAL ASSOCIATION 2015 Annual Meeting Accountable Care Organizations Comprehensive Integration Strategy ACO Development Market Conditions Increasing Economic pressures Consumerism Regulatory scrutiny

More information

Critical Access Hospitals and

Critical Access Hospitals and Critical Access Hospitals and Health Care Reform What s in it for you? Patient Protection and Affordable Care Act (ACA) Fundamental changes Moving Medicare from payment for services to payment for outcomes

More information

Medicare Accountable Care Organizations: What it s about

Medicare Accountable Care Organizations: What it s about Medicare Accountable Care Organizations: What it s about Gail Albertson, MD Associate Professor of Medicine Chief Operating Officer, UPI Medicare Accountable Care Under the Medicare Shared Savings Program

More information

Newsroom. The quality measures are organized into four domains:

Newsroom. The quality measures are organized into four domains: Newsroom People with Medicare will be able to benefit from a new program designed to encourage primary care doctors, specialists, hospitals, and other care providers to coordinate their care under a final

More information

Federal Fraud and Abuse Laws

Federal Fraud and Abuse Laws Federal Fraud and Abuse Laws Remaining in Compliance while Attesting to Meaningful Use 1 Overview This presentation provides an overview of key Federal laws aimed at preventing healthcare fraud and abuse

More information

The Regulations Are Out: Is An ACO Right For You? Moderator David Pursell 816.983.8190 david.pursell@huschblackwell.com

The Regulations Are Out: Is An ACO Right For You? Moderator David Pursell 816.983.8190 david.pursell@huschblackwell.com The Regulations Are Out: Is An ACO Right For You? Moderator David Pursell 816.983.8190 david.pursell@huschblackwell.com Today s Discussion Overview of the ACO Regulations Alternatives to a Medicare ACO

More information

CHAPTER 114. AN ACT establishing a Medicaid Accountable Care Organization Demonstration Project and supplementing Title 30 of the Revised Statutes.

CHAPTER 114. AN ACT establishing a Medicaid Accountable Care Organization Demonstration Project and supplementing Title 30 of the Revised Statutes. CHAPTER 114 AN ACT establishing a Medicaid Accountable Care Organization Demonstration Project and supplementing Title 30 of the Revised Statutes. BE IT ENACTED by the Senate and General Assembly of the

More information

Why Worry? Fraud and Abuse Risks for Managed Care Organizations. Overview

Why Worry? Fraud and Abuse Risks for Managed Care Organizations. Overview Why Worry? Fraud and Abuse Risks for Managed Care Organizations Stephen K. Warch Shareholder, Nilan Johnson Lewis Overview Risks Created by Incentives Offered by Health Plans and Providers o Prohibition

More information

Physician Integration Models: ACOs as the Latest and Greatest? David T. Lewis david.lewis@lpnt.net LifePoint Hospitals, Inc.

Physician Integration Models: ACOs as the Latest and Greatest? David T. Lewis david.lewis@lpnt.net LifePoint Hospitals, Inc. Physician Integration Models: ACOs as the Latest and Greatest? David T. Lewis david.lewis@lpnt.net LifePoint Hospitals, Inc. Brentwood, TN Kim Harvey Looney kim.looney@wallerlaw.com Waller Lansden Dortch

More information

Accountable Care Organizations: Importance to Physicians in Value Based Payment June 19, 2014 12:00-1:00pm EST

Accountable Care Organizations: Importance to Physicians in Value Based Payment June 19, 2014 12:00-1:00pm EST Accountable Care Organizations: Importance to Physicians in Value Based Payment June 19, 2014 12:00-1:00pm EST Ahmed Haque, Director of Care Transformation Health IT U.S. Department of Health & Human Services

More information

Client Advisory. CMS Issues Final ACO Regulations EXECUTIVE SUMMARY. Health Care. Eligibility. November 10, 2011

Client Advisory. CMS Issues Final ACO Regulations EXECUTIVE SUMMARY. Health Care. Eligibility. November 10, 2011 Client Advisory Health Care November 10, 2011 CMS Issues Final ACO Regulations After receiving more than 1,300 public comments on its Proposed Rule for Accountable Care Organizations (ACOs) under the Medicare

More information

Medical Group Development, PHOs, MSOs, Nonprofit Medical Foundations and Fully Integrated Delivery Systems

Medical Group Development, PHOs, MSOs, Nonprofit Medical Foundations and Fully Integrated Delivery Systems Medical Group Development, PHOs, MSOs, Nonprofit Medical Foundations and Fully Integrated Delivery Systems Medical Group Formation Medical Group Foundation Physician Hospital Organizations (PHOs) Management

More information

PPACA: IMPACT ON MEDICAL PRACTICES AND CARE DELIVERY ROSA FINI, M.D. APRIL 2013

PPACA: IMPACT ON MEDICAL PRACTICES AND CARE DELIVERY ROSA FINI, M.D. APRIL 2013 PPACA: IMPACT ON MEDICAL PRACTICES AND CARE DELIVERY ROSA FINI, M.D. APRIL 2013 1 A SYSTEMS ORGANIZATION CHANGE COMPREHENSIVE SYSTEM REFORM IMPACTS: REIMBURSEMENT MECHANISMS MEDICAL CARE DELIVERY MODEL

More information

Thursday, October 10, 2013 POTENTIAL BARRIERS TO HOSPITAL SUBSIDIES FOR HEALTH INSURANCE FOR THOSE IN NEED

Thursday, October 10, 2013 POTENTIAL BARRIERS TO HOSPITAL SUBSIDIES FOR HEALTH INSURANCE FOR THOSE IN NEED Thursday, October 10, 2013 POTENTIAL BARRIERS TO HOSPITAL SUBSIDIES FOR HEALTH INSURANCE FOR THOSE IN NEED AT A GLANCE The Issue: A number of hospitals and health systems have inquired about whether it

More information

Provider Integration Can Save Needed Dollars for Reform

Provider Integration Can Save Needed Dollars for Reform New York Law Journal July 26, 2010 Provider Integration Can Save Needed Dollars for Reform Overcoming legal, regulatory obstacles will be crucial. By Richard J. Zall and Elizabeth M. Mills The proponents

More information

The Impact of Accountable Care Organizations (ACOs) on Credentialing and Privileging

The Impact of Accountable Care Organizations (ACOs) on Credentialing and Privileging The Impact of Accountable Care Organizations (ACOs) on Credentialing and Privileging Michael R. Callahan Katten Muchin Rosenman LLP 525 W. Monroe Chicago, Illinois 312.902.5634 michael.callahan@kattenlaw.com

More information

Accountable Care Organization Provisions in the Patient Protection and Affordable Care Act

Accountable Care Organization Provisions in the Patient Protection and Affordable Care Act Accountable Care Organization Provisions in the Patient Protection and Affordable Care Act The consolidated Patient Protection and Affordable Care Act 1 is 974 pages long. Text related to Accountable Care

More information

Accountable Care Organizations: An old idea with new potential. Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010

Accountable Care Organizations: An old idea with new potential. Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010 Accountable Care Organizations: An old idea with new potential Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010 Impetus for ACO Formation Increased health care cost From

More information

CMS ACO Proposed Regulations

CMS ACO Proposed Regulations CMS ACO Proposed Regulations May 2011 Proposed CMS ACO Regulations Proposed Regulations issued March 31, 2011 Comments due back June 6, 2011 Requires 3 year binding commitment Formal Legal Structure Required

More information

Healthcare Reform Update Conference Call VI

Healthcare Reform Update Conference Call VI Healthcare Reform Update Conference Call VI Sponsored by the Healthcare Reform Educational Task Force October 9, 2009 2:00-2:45 2:45 pm Eastern Healthcare Delivery System Reform Provisions in America s

More information

Medicare ACO Road Map

Medicare ACO Road Map PYALeadership Briefing Medicare ACO Road Map January, 2013 Medicare ACO Road Map The Centers for Medicare & Medicaid Services ( CMS ) has announced 106 new accountable care organizations ( ACOs ) have

More information

Cms Finally speaks: organization (ACO) proposed regulations and WhaT They mean For anesthesiologists

Cms Finally speaks: organization (ACO) proposed regulations and WhaT They mean For anesthesiologists ANESTHESIA BUSINESS CONSULTANTS SUMMER 2011 VOLUME 16, ISSUE 2 Cms Finally speaks: The accountable Care organization (ACO) proposed regulations and WhaT They mean For anesthesiologists Since the passage

More information

GAO MEDICARE. Implementation of Financial Incentive Programs under Federal Fraud and Abuse Laws. Report to Congressional Requesters

GAO MEDICARE. Implementation of Financial Incentive Programs under Federal Fraud and Abuse Laws. Report to Congressional Requesters GAO United States Government Accountability Office Report to Congressional Requesters March 2012 MEDICARE Implementation of Financial Incentive Programs under Federal Fraud and Abuse Laws GAO-12-355 March

More information

Brief Course. Neil Kirschner, Ph.D. Director, Regulatory and Insurer Affairs

Brief Course. Neil Kirschner, Ph.D. Director, Regulatory and Insurer Affairs Accountable Care Organization (ACO) 101 Brief Course Neil Kirschner, Ph.D. Director, Regulatory and Insurer Affairs What is an ACO? ACO refers to a legal entity composed of a group of providers that assume

More information

Fraud, Waste, and Abuse

Fraud, Waste, and Abuse These training materials are divided into three topics to meet the responsibilities stated on the previous pages: Fraud, Waste, Compliance Program Standards of Conduct Although the information contained

More information

The Internal Revenue Service (IRS) is considering the application of the. provisions of the Internal Revenue Code (Code) governing tax-exempt bonds to

The Internal Revenue Service (IRS) is considering the application of the. provisions of the Internal Revenue Code (Code) governing tax-exempt bonds to Part III - Administrative, Procedural, and Miscellaneous Private business use of tax-exempt bond financed facilities Notice 2014-67 SECTION 1. INTRODUCTION The Internal Revenue Service (IRS) is considering

More information

New Safe Harbors and Stark Exceptions for Electronic Prescribing and Electronic Health Records Arrangements

New Safe Harbors and Stark Exceptions for Electronic Prescribing and Electronic Health Records Arrangements New Safe Harbors and Stark Exceptions for Electronic Prescribing and Electronic Health Records Arrangements November 15, 2006 Steve Nash and Sara Hill, Holme Roberts & Owen LLP Agenda Introduction Background

More information

Telemedicine and E-Health Law.

Telemedicine and E-Health Law. Brochure More information from http://www.researchandmarkets.com/reports/2131603/ Telemedicine and E-Health Law. Description: The use of the Internet and high-tech communications in health care has led

More information

AHLA. BB. Accountable Care Organizations and the Medicare Shared Savings Program. Troy Barsky Crowell & Moring LLP Washington, DC

AHLA. BB. Accountable Care Organizations and the Medicare Shared Savings Program. Troy Barsky Crowell & Moring LLP Washington, DC AHLA BB. Accountable Care Organizations and the Medicare Shared Savings Program Troy Barsky Crowell & Moring LLP Washington, DC Daniel F. Murphy Bradley Arant Boult Cummings LLP Birmingham, AL Terri L.

More information

Healthcare Reform: The Road Ahead

Healthcare Reform: The Road Ahead Healthcare Reform: The Road Ahead Kevin Lyles, Esq. Partner, Jones Day kdlyles@jonesday.com (614) 281-3821 Frank E. Sheeder, Esq. Partner, DLA Piper frank.sheeder@dlapiper.com (214) 743-4560 Diane Meyer

More information

ANNALS OF HEALTH LAW Advance Directive VOLUME 20 FALL 2010 PAGES 1-10

ANNALS OF HEALTH LAW Advance Directive VOLUME 20 FALL 2010 PAGES 1-10 ANNALS OF HEALTH LAW Advance Directive VOLUME 20 FALL 2010 PAGES 1-10 Accountable Care Organizations: Providing Quality Healthcare in an Integrated System Doriann Cain* I. INTRODUCTION A new era of health

More information

Becoming an ACO The Rules and Requirements

Becoming an ACO The Rules and Requirements Becoming an ACO The Rules and Requirements Drinker Biddle ACO Workgroup Webinar November 3, 2011 Speakers Matthew Amodeo, Partner Drinker Biddle & Reath LLP Albany, N.Y. Matthew.Amodeo@dbr.com (518) 862-7468

More information

How State Law Issues May Affect ACOs

How State Law Issues May Affect ACOs 13 How State Law Issues May Affect ACOs Michael F. Schaff Alyson M. Leone Grace D. Mack Wilentz, Goldman & Spitzer, P.A. 1 13.1 Introduction With the arrival of federal health care reform, the heatlth

More information

ACCOUNTABLE CARE ORGANIZATIONS

ACCOUNTABLE CARE ORGANIZATIONS ACCOUNTABLE CARE ORGANIZATIONS Implementing Efficient, Value-Based Health Care Programs Prepared by Sara Watson September 2010 Table of Contents Abstract.. pg. 2 Overview.pg. 2-3 Background...pg. 2-3 Introduction...pg.

More information

Alan K. Parver Darryl Drevna SUBJECT: Accountable Care Organizations DATE: August 24, 2010

Alan K. Parver Darryl Drevna SUBJECT: Accountable Care Organizations DATE: August 24, 2010 TO: FROM: Alan K. Parver Darryl Drevna SUBJECT: Accountable Care Organizations DATE: August 24, 2010 The following is an overview of Accountable Care Organizations (ACOs), a shared savings program used

More information

PHYSICIAN/HOSPITAL FINANCIAL ARRANGEMENTS POST-TEST. Name: Date: Practice Plan:

PHYSICIAN/HOSPITAL FINANCIAL ARRANGEMENTS POST-TEST. Name: Date: Practice Plan: PHYSICIAN/HOSPITAL FINANCIAL ARRANGEMENTS POST-TEST Name: Date: Practice Plan: Phone: E-mail: ************************************************************************ 1. Which of the following legislation

More information

Participating Accountable Care Organizations (ACOs) that meet quality performance standards will be eligible to receive payments for shared savings.

Participating Accountable Care Organizations (ACOs) that meet quality performance standards will be eligible to receive payments for shared savings. Background Sec. 3022 of the Patient Protection and Affordable Care Act (PPACA) requires the Secretary to establish the Medicare Shared Savings Program by Jan. 1, 2012 Program goals: Promote accountability

More information

The Impact of the PPACA on Fraud and Abuse Issues

The Impact of the PPACA on Fraud and Abuse Issues The Impact of the PPACA on Fraud and Abuse Issues American Bar Association May 5, 2010 Kirk Ogrosky, Arnold & Porter LLP Lisa M. Ohrin, Katten Muchin Rosenman LLP Donald H. Romano, Arent Fox LLP The Patient

More information

Compliance and Program Integrity Melanie Bicigo, CHC, CEBS mlbicigo@uphp.com 906-225-7749

Compliance and Program Integrity Melanie Bicigo, CHC, CEBS mlbicigo@uphp.com 906-225-7749 Compliance and Program Integrity Melanie Bicigo, CHC, CEBS mlbicigo@uphp.com 906-225-7749 Define compliance and compliance program requirements Communicate Upper Peninsula Health Plan (UPHP) compliance

More information

Transforming Health Care Through Accountable Care Organizations. A Critical Assessment

Transforming Health Care Through Accountable Care Organizations. A Critical Assessment Transforming Health Care Through Accountable Care Organizations A Critical Assessment 2010 Editors: Contributors: Michael L. Blau Boston, Massachusetts 617.342.4040 mblau@foley.com C. Frederick Geilfuss

More information

Fraud, Waste & Abuse. Training Course for UHCG Employees

Fraud, Waste & Abuse. Training Course for UHCG Employees Fraud, Waste & Abuse Training Course for UHCG Employees Overview The Centers for Medicare & Medicaid Services (CMS) require Medicare Advantage Organizations and Part D Plan Sponsors to provide annual fraud,

More information

Fraud, Waste and Abuse Prevention Training

Fraud, Waste and Abuse Prevention Training Fraud, Waste and Abuse Prevention Training The Centers for Medicare & Medicaid Services (CMS) requires annual fraud, waste and abuse training for organizations providing health services to MA or Medicare

More information

Accountable Care Organizations

Accountable Care Organizations Building a Healthy ACO Compliance Program HCCA 2014 Compliance Institute Mary C. Malone, Esq. Hancock, Daniel, Johnson & Nagle, P.C. Disclaimer: The content of this presentation does not constitute legal

More information

Bundled Payment and Health Care Reform

Bundled Payment and Health Care Reform Bundled Payment and Health Care Reform A Users Guide to Current Legal Issues June 2012 Prepared by Gerald A. Niederman Shareholder, Health Care Practice Group, Law Firm Polsinelli Shughart, PC 303-583-8204;

More information

M E M O R A N D U M. CMS Proposed Rule & Related Agency Notices on Accountable Care Organizations

M E M O R A N D U M. CMS Proposed Rule & Related Agency Notices on Accountable Care Organizations 1501 M Street NW Seventh Floor Washington, DC 20005-1700 Tel: 202.466.6550 Fax: 202.785.1756 M E M O R A N D U M To: From: Clients and Friends Powers Pyles Sutter & Verville, PC Date: April 10, 2011 Re:

More information

Characteristics of Accountable and Community Care Organizations (ACOs and CCOs)

Characteristics of Accountable and Community Care Organizations (ACOs and CCOs) ACO Definition Organization of providers that shares responsibility for providing care to patients and is accountable for the care of beneficiaries assigned to it. Major Specifically addressed in the Differences

More information

Accountable Care Organizations and Coordinated Care Organizations

Accountable Care Organizations and Coordinated Care Organizations ACO Definition Organization of providers that shares responsibility for providing care to patients and is accountable for the care of beneficiaries assigned to it. Major Specifically addressed in the Differences

More information